Methods and devices for providing access into a body cavity

ABSTRACT

Methods and devices are provided for providing surgical access into a body cavity. In general, the methods and devices allow a surgical access device to be securely positioned within an opening in tissue to provide access to a body cavity underlying the tissue. An actuator can be rotatably disposed on or in a housing of a surgical access device such that rotation of the actuator relative to the housing is effective to move a cannula of the surgical access device between an insertion configuration in which the cannula has a reduced profile enabling it to easily be inserted into a tissue opening, and an expanded profile enabling it to form an anchor against and/or within the tissue opening.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is being filed with U.S. application Ser. No.12/635,754 entitled “Methods and Devices For Providing Access Into aBody Cavity,” which is incorporated by reference herein in its entirety.

FIELD OF THE INVENTION

The present invention relates to methods and devices for providingsurgical access into a body cavity.

BACKGROUND OF THE INVENTION

Access ports are widely used in medical procedures to gain access toanatomical cavities ranging in size from the abdomen to small bloodvessels, such as veins and arteries, epidural, pleural and subarachnoidspaces, heart ventricles, and spinal and synovial cavities. The use ofaccess ports has become more common as they provide minimally invasivetechniques for establishing a portal for a number of procedures, such asthose involving the abdominal cavity. Reduced postoperative recoverytime, markedly decreased post-operative pain and wound infection, andimproved cosmetic outcome are well established benefits of minimallyinvasive surgery, derived mainly from the ability of surgeons to performan operation utilizing smaller incisions of the body cavity wall.

In many surgical procedures, it is desirable to provide one or moreworking channels into a body cavity through which various instrumentscan be passed to view, engage, and/or treat tissue to achieve adiagnostic or therapeutic effect. In laparoscopic abdominal proceduresfor example, the abdominal cavity is generally insufflated with CO₂ gasto a pressure of around 15 mm Hg. The abdominal wall is pierced and oneor more tubular cannulas, each defining a working channel, are insertedinto the abdominal cavity. A laparoscopic telescope connected to anoperating room monitor can be used to visualize the operative field andcan be placed through one of the working channels. Other laparoscopicinstruments such as graspers, dissectors, scissors, retractors, etc. canalso be placed through one or more of the working channels to facilitatevarious manipulations by the surgeon and/or surgical assistant(s).

One problem with existing methods and devices is that existing surgicalaccess devices do not retract tissue beyond the initial incision to anyappreciable degree. It can thus be difficult to position a surgicalaccess device in the incision, particularly in minimally invasivesurgical procedures where the incision is relatively small. It can alsobe difficult as an initial matter to choose an appropriately sizedaccess device to position within the incision during the stress and timeconstraints of surgery.

Removal of an access device from an incision in tissue can presentfurther challenges when the access device is snugly positioned therein,requiring an amount of pullout force that can cause damage to the tissueand/or prolong length of the surgical procedure. Such forceful removalof the access device can also increase the size of the incision, therebyreducing the healing and cosmetic benefits of a minimally invasivesurgical procedure.

Accordingly, there remains a need for methods and devices for providingsurgical access into a body cavity.

SUMMARY OF THE INVENTION

The present invention generally provides methods and devices forproviding surgical access into a body cavity. In one embodiment, anadjustable access device is provided and can include a housing having acannula extending distally therefrom defining a working channelextending therethrough for receiving surgical instruments. The housingcan have one or more ports formed therein for receiving surgicalinstruments, and at least one seal can be disposed in the workingchannel and can be configured to form at least one of a seal around aninstrument disposed through the working channel and a seal across theworking channel when no instrument is disposed through the workingchannel. The surgical access device can also include an actuatorrotatably disposed on the housing such that rotation of the actuatorrelative to the housing is effective to move the cannula between aninsertion configuration in which the cannula has a first outer diameterand a first length, and a deployed configuration in which the cannulahas a second outer diameter and a second length. In an exemplaryembodiment, the first outer diameter can be less than the first lengthof the cannula and the second outer diameter can be greater than thefirst outer diameter and the second length being less than the firstlength. The second outer diameter can be less than the second length ofthe cannula.

While the cannula can have many configurations, in one exemplaryembodiment, the cannula can include a flexible band formed into a helixhaving a plurality of coils. Adjacent coils can be mated together usingany mechanism known in the art, for example, they can be mated to oneanother by a mating feature formed on the coils. The mating feature caninclude one of a male track and a female track formed on a first edge ofeach coil, and one of a complementary male track or female track formedon a second opposite edge of each coil.

In other exemplary embodiments, a proximal portion of the flexible bandcan be mated to the actuator. Rotation of the actuator to move thecannula to the insertion configuration can be effective to wind theproximal portion of the flexible band around the actuator to cause thecannula to increase in length and decrease in diameter to facilitateinsertion of the cannula into and removal of the cannula from a tissueopening. Rotation of the actuator to the deployed configuration can beeffective to unwind the proximal portion of the flexible band fromaround the actuator to cause the cannula to decrease in length andincrease in diameter. In one embodiment, the cannula can be configuredto engage a tissue opening in the deployed configuration to therebystabilize the access device.

In other aspects, an adjustable access device is provided and caninclude a housing having an adjustable cannula extending therefrom. Thehousing and the cannula can define a working channel therethrough. Theadjustable cannula can include a flexible band wound into a helicalspring such that a proximal end of the flexible band is coupled to thehousing and a distal end of the band is positioned at a distal end ofthe adjustable cannula. In some embodiments, the adjustable cannula canhave an insertion configuration with an increased length and decreaseddiameter for insertion into a tissue opening and a deployedconfiguration with a decreased length and increased diameter foranchoring within a tissue opening.

The housing can include an actuator coupled to the proximal end of theflexible band and configured to rotate the proximal end of the flexibleband to move the cannula between the insertion and deployedconfigurations. The adjustable cannula can have a substantially constantfirst diameter in the insertion configuration and a substantiallyconstant second diameter in the deployed configuration. In someembodiments, the flexible band can be formed into a helix having aplurality of coils coupled together.

Exemplary methods are also provided and in one embodiment, a method ofproviding access through tissue to a body cavity is provided and caninclude positioning a cannula in an opening in tissue such that aworking channel of the cannula provides access through the tissue andinto a body cavity. The method can also include rotating an actuator tomove the cannula from an insertion configuration to a deployedconfiguration in which the cannula decreases in length and increases indiameter, and rotating the actuator to move the cannula to the insertionconfiguration in which the cannula increases in length and decreases indiameter to increase a size of the opening in the tissue. The method canfurther include removing the cannula from the opening in tissue. In someembodiments, rotating the actuator to move the cannula to the deployedconfiguration can anchor the cannula against the tissue through which itextends.

Rotating the actuator to move the cannula to the insertion configurationcan wind a proximal end of a flexible band around the actuator totighten a helix formed by the flexible band. Furthermore, rotating theactuator to move the cannula to the deployed configuration can unwind aproximal end of a flexible band from around the actuator to loosen ahelix formed by the flexible band.

In other aspects, an adjustable access device is provided and caninclude a housing having an adjustable cannula extending distallytherefrom. The adjustable cannula can be movable between an insertionconfiguration and a deployed configuration in which a distal portion ofthe cannula inverts radially outward relative to a proximal portion ofthe cannula to form an anchor configured for stabilizing the accessdevice. The anchor can have a diameter greater than a diameter of theproximal portion of the cannula. In some embodiments, the cannula can beconfigured to telescope within the housing in the insertionconfiguration.

The adjustable access device can also include a rotatable actuatordisposed on the housing and configured to move the cannula between theinsertion configuration and the deployed configuration. The cannula canbe formed from many materials, for example, the cannula can be formed ofa plurality of fibers woven into a mesh material. The rotatable actuatorcan be configured to decrease a length of at least some of the pluralityof fibers extending from the housing to move the cannula to the deployedconfiguration.

In other embodiments, an adjustable access device is provided that caninclude a housing and a cannula formed of a weave of fibers extendingdistally from the housing. The housing and the cannula can define aworking channel extending therethrough for receiving instruments. In oneexemplary embodiment, an actuator can be rotatably disposed on thehousing such that rotation of the actuator in a first direction relativeto the housing is effective to cause a distal portion of the cannula toinvert radially outward into a deployed configuration to form a distalanchor to engage tissue. The distal anchor can include a distal rimconfigured to engage tissue when the distal anchor is in the deployedconfiguration.

In some embodiments, a first group of fibers from the weave of fiberscan be coupled to the actuator, and a second group of fibers from theweave of fibers can not be coupled to the actuator. Rotation of theactuator in the first direction can be effective to shorten a length ofthe first group of fibers, and the second group of fibers can beconfigured to maintain an original length when the actuator is rotatedin the first direction. The actuator can be rotatable in a secondopposite direction to move the anchor portion of the cannula from thedeployed configuration to an insertion configuration in which thecannula has a substantially constant outer diameter.

The housing can have many configurations and can include any number ofsealing ports formed therein. In some embodiments, the cannula can beconfigured to telescope longitudinally through the housing when theactuator is rotated in the first direction. The anchor portion can haveany diameter as needed, for example, the anchor portion can have adiameter substantially greater than a diameter of the cannula when inthe deployed configuration. The device can further include at least onesealing element disposed within the working channel that can beeffective to form at least one of a seal around an instrument insertedthrough the working channel and a seal across the working channel whenno instrument is inserted through the working channel.

A method of providing access through tissue to a body cavity is alsoprovided and can include positioning a cannula of a surgical accessdevice into an opening within tissue, and rotating an actuator of thesurgical access device to move the cannula from an insertionconfiguration to a deployed configuration in which a distal portion ofthe cannula inverts radially outward relative to a proximal portion ofthe cannula to form an anchor against the tissue.

The cannula can be formed of any material, but in one embodiment, thecannula is formed of a plurality of fibers woven into a mesh materialand rotating the actuator to move the cannula to the deployedconfiguration rotates a first group of the plurality of fibers toshorten the fibers relative to a second group of the plurality of fibersto invert the cannula. In addition, rotating the actuator to move acannula longitudinally through the housing can telescope the cannulalongitudinally through the housing.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1A is a perspective view of one embodiment of an adjustablesurgical access device having a helical cannula shown in a deployedconfiguration;

FIG. 1B is a perspective view of the device of FIG. 1A showing thecannula in an insertion configuration;

FIG. 1C is a perspective cross-sectional view of the cannula of thedevice of FIG. 1A

FIG. 2A is a cross-sectional view of another embodiment of an adjustablesurgical access device having an invertible anchor shown in an insertionconfiguration;

FIG. 2B is a perspective view of the device of FIG. 2A showing theanchor in a deployed configuration;

FIG. 3A is a partial cross-sectional view of one embodiment of anadjustable surgical access device having a cannula in the form of aretractable bellows shown in an insertion configuration;

FIG. 3B is a partial cross-sectional view of the device of FIG. 3Ashowing an obturator being removed;

FIG. 3C is a partial cross-sectional view of the device of FIG. 3Ashowing the cannula in a deployed configuration;

FIG. 4A is a partial cross-sectional view of another embodiment of anadjustable surgical access device shown in an insertion configuration;

FIG. 4B is a partial cross-sectional view of the device of FIG. 4A shownin a deployed configuration;

FIG. 5A is a perspective view of an embodiment of an adjustable surgicalaccess device having a wire shown in an insertion configuration;

FIG. 5B is a perspective view of the device of FIG. 5A showing the wirein a deployed configuration;

FIG. 5C is a top view of multiple wire embodiments usable with thedevice of FIG. 5A;

FIG. 6A is a partial cross-sectional view of another embodiment of anadjustable surgical access device having a flexible cannula withmultiple stability rings shown in an insertion configuration;

FIG. 6B is a partial cross-sectional view of the device of FIG. 6Ashowing the cannula in a deployed configuration;

FIG. 6C is a cross-sectional view of the device of FIG. 6A showing anactuator;

FIG. 7A is a side view of one embodiment of an adjustable surgicalaccess device having an obturator disposed therein for mounting aflexible cannula of the device in an insertion configuration;

FIG. 7B is a side view of the device of FIG. 7A showing the flexiblecannula in which the obturator has released the flexible cannula;

FIG. 7C is a partial cross-sectional view of the device of FIG. 7A in adeployed configuration;

FIG. 7D is a perspective view of an actuator of the device of FIG. 7A;and

FIG. 7E is a partial cross-sectional view of the actuator of FIG. 7D.

DETAILED DESCRIPTION OF THE INVENTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Various exemplary methods and devices are provided for surgicallyaccessing a body cavity. In general, the methods and devices allow asurgical access device to be securely positioned within an opening intissue to provide access to a body cavity underlying the tissue. In oneembodiment, an adjustable access device is provided and can include ahousing having a cannula extending distally therefrom. The housing andthe cannula can define a working channel extending therethrough forreceiving surgical instruments. The adjustable access device can furtherinclude at least one seal disposed within the working channel andconfigured to form at least one of a seal around an instrument disposedthrough the working channel and a seal when no instrument is disposedthrough the working channel. An actuator can be rotatably disposed on orin the housing such that rotation of the actuator relative to thehousing is effective to move the cannula between an insertionconfiguration in which the cannula has a reduced profile enabling it toeasily be inserted into a tissue opening, and an expanded configurationenabling the cannula to form an anchor against and/or within the tissueopening.

The adjustable access device can allow for ease of insertion into anopening in tissue. An exemplary cannula of the surgical access devicecan have a reduced profile in an insertion configuration so that it canbe inserted into a smaller tissue opening. A smaller tissue opening canimprove recovery time and cosmetic outcome of a procedure. Oncepositioned within the tissue opening, the cannula of the adjustableaccess device can be moved to a deployed configuration that can provideactive retraction of the tissue opening to help anchor the device withinthe tissue. Such anchoring can help form a better seal between thetissue and the device and help retain the device in a more stableposition within the tissue. Once a procedure is complete, the cannula ofthe surgical access device can be returned to its reduced profileinsertion configuration to enable easy removal from the tissue opening.

The various surgical access devices described herein can generally beconfigured to allow one or more surgical instruments to be insertedthrough one or more independent sealing ports or access ports formed ina housing of the device and into a body cavity. The sealing ports caneach define working channels extending through the housing and incommunication with a cannula extending distally from the housing. Thecannula can be configured as a wound protector, retractor, or othermember for forming a pathway through tissue. The cannula can generallybe configured to be positioned within any opening in a patient's body,including a natural opening or an incision. The elasticity of the skinof the patient can assist in the retention of the cannula in the bodyopening or incision made in the body. In one embodiment, the cannula canbe substantially flexible so that it can be easily maneuvered into andwithin tissue as needed. In other embodiments, the cannula can besubstantially rigid or substantially semi-rigid and adjustable orexpandable in shape/size. The cannula can be formed of any suitablematerial known in the art, e.g., silicone, urethane, thermoplasticelastomer, and rubber.

Any and all of the surgical access devices described herein can alsoinclude various other features, such as one or more ventilation ports toallow evacuation of smoke during procedures that utilize cautery, and/orone or more insufflation ports through which the surgeon can insufflatethe abdomen to cause pneumoperitenium, as described by way ofnon-limiting example in U.S. Patent Application No. 2006/0247673entitled “Multi-port Laparoscopic Access Device” filed Nov. 2, 2006,which is hereby incorporated by reference in its entirety. Theinsufflation port can be located anywhere on the device, can have anysize, and can accept a leur lock or a needle, as will be appreciated bythose skilled in the art.

Any and all embodiments of a surgical access device can also include oneor more safety shields positioned through, in, and around any of thecomponents and/or tissue to protect the components against puncture ortear by surgical instruments being inserted through the device.Exemplary embodiments of safety shields are described in more detail inU.S. Patent Publication No. 2006/0247673 entitled “Multi-portLaparoscopic Access Device” filed Nov. 2, 2006, U.S. patent applicationSer. No. 12/399,625 entitled “Methods and Devices for Providing Accessto a Body Cavity” filed on Mar. 6, 2009, U.S. patent application Ser.No. 12/399,482 entitled “Methods and Devices for Providing Access to aBody Cavity” filed on Mar. 6, 2009, and U.S. patent application Ser. No.12/242,765 entitled “Surgical Access Device” filed on Sep. 30, 2008,which are hereby incorporated by reference in their entireties.

In any and all of the surgical access device embodiments disclosedherein, an engagement and/or release mechanism can be included to allowcertain components of the surgical access device to be removable asneeded. Any engagement and release mechanism known in the art, e.g., asnap-lock mechanism, corresponding threads, etc., can be used toreleasably mate components of the device. Exemplary embodiments ofengagement and release mechanisms are described in more detail inpreviously mentioned U.S. patent application Ser. No. 12/242,765entitled “Surgical Access Device” filed on Sep. 30, 2008, U.S. patentapplication Ser. No. 12/399,625 entitled “Methods and Devices forProviding Access to a Body Cavity” filed on Mar. 6, 2009, and U.S.patent application Ser. No. 12/399,482 entitled “Methods and Devices forProviding Access to a Body Cavity” filed on Mar. 6, 2009 and in U.S.Pat. No. 7,371,227 entitled “Trocar Seal Assembly,” issued May 13, 2008and U.S. Pat. No. 5,628,732 entitled “Trocar With Improved UniversalSeal,” issued May 13, 2007, which are hereby incorporated by referencein their entireties.

Typically, during surgical procedures in a body cavity, such as theabdomen, insufflation is provided through the surgical access device toexpand the body cavity to facilitate the surgical procedure. Thus, inorder to maintain insufflation within the body cavity, most surgicalaccess devices include at least one seal disposed therein to prevent airand/or gas from escaping when surgical instruments are insertedtherethrough. Various sealing elements are known in the art, buttypically the surgical access device can include at least one instrumentseal that forms a seal around an instrument disposed therethrough, butotherwise does not form a seal when no instrument is disposedtherethrough; at least one channel seal or zero-closure seal that sealsthe working channel created by the sealing port when no instrument isdisposed therethrough; or a combination instrument seal and channel sealthat is effective to both form a seal around an instrument disposedtherethrough and to form a seal in the working channel when noinstrument is disposed therethrough. A person skilled in the art willappreciate that various seals known in the art can be used including,e.g., duckbill seals, cone seals, flapper valves, gel seals, diaphragmseals, lip seals, iris seals, etc. A person skilled in the art will alsoappreciate that any combination of seals can be included in any of theembodiments described herein, whether or not the seal combinations arespecifically discussed in the corresponding description of a particularembodiment. Exemplary embodiments of various seal protectors aredescribed in more detail in U.S. Pat. No. 5,342,315 entitled “TrocarSeal/Protector Assemblies,” issued Aug. 30, 1994 and U.S. Pat. No.7,163,525 entitled “Duckbill Seal Protector,” issued Jan. 16, 2007,which are hereby incorporated by reference in their entireties.

FIGS. 1A and 1B illustrate one embodiment of a surgical access device 10having a housing 12 configured to have one or more surgical instrumentsinserted therethrough. The housing 12 can be fixedly or removablycoupled to a cannula 14 that extends distally from the housing 12 toprovide a pathway through tissue into a body cavity. The housing 12 canbe in a fixed position relative to the cannula 14 as shown in thisembodiment, or the housing 12 can be movable relative to the cannula 14.Exemplary embodiments of various housings are described in more detailin previously mentioned U.S. Patent Publication No. 2006/0247673entitled “Multi-port Laparoscopic Access Device” filed Nov. 2, 2006,U.S. patent application Ser. No. 12/399,625 entitled “Methods andDevices for Providing Access to a Body Cavity” filed on Mar. 6, 2009,U.S. patent application Ser. No. 12/399,482 entitled “Methods andDevices for Providing Access to a Body Cavity” filed on Mar. 6, 2009,and U.S. patent application Ser. No. 12/242,765 entitled “SurgicalAccess Device” filed on Sep. 30, 2008, and in U.S. patent applicationSer. No. 12/399,547 entitled “Surgical Access Devices And MethodsProviding Seal Movement In Predefined Paths” filed on Mar. 6, 2009,which is hereby incorporated by reference in its entirety.

While any number of sealing ports can be formed in the housing 12, inthe illustrated embodiment, three sealing ports 16 a, 16 b, 16 c extendthrough the housing 12. The sealing ports 16 a, 16 b 16 c each have acentral axis that extends substantially parallel with a centrallongitudinal axis of the housing 12, but any one or more of the sealingports 16 a, 16 b, 16 c can be angled relative to the housing 12 and/orrotatable or otherwise movable relative to the housing 12. Additionallyor alternatively, any one or more of the sealing ports 16 a, 16 b, 16 ccan be configured to be movable relative to any one or more portions ofthe cannula 14 and/or any others of the sealing ports 16 a, 16 b, 16 c.Each sealing port, or any other portion of the housing or cannula, caninclude one or more sealing elements. A sealing element can include aninstrument seal, a channel seal, and/or a combination instrument/channelseal as previously discussed herein. As will be appreciated by thoseskilled in the art, any configuration and any number of sealing portscan be used in any of the housing and cannula embodiments disclosedherein. Exemplary embodiments of various sealing ports are described inmore detail in previously mentioned U.S. Patent Publication No.2006/0247673 entitled “Multi-port Laparoscopic Access Device” filed Nov.2, 2006, U.S. patent application Ser. No. 12/399,625 entitled “Methodsand Devices for Providing Access to a Body Cavity” filed on Mar. 6,2009, U.S. patent application Ser. No. 12/399,482 entitled “Methods andDevices for Providing Access to a Body Cavity” filed on Mar. 6, 2009,and U.S. patent application Ser. No. 12/242,765 entitled “SurgicalAccess Device” filed on Sep. 30, 2008.

While the cannula 14 can have any configuration known in the art, in theillustrated embodiment, the cannula 14 is in the shape of a cylindricalelongate member having a proximal end 20 and a substantially constantouter diameter that terminates in a conical distal tip 18, however thedistal end 18 can have any configuration, including cylindrical. Thedistal end 18 can have an opening 19 formed therein for receiving anobturator or other tissue penetrating tool, as well as surgicalinstruments inserted through the device 10. In an exemplary embodiment,a length of the cannula 14 is generally greater than a diameter of thecannula 14, although it will be appreciated that in some embodiments,the diameter of the cannula 14 could possibly be greater than itslength. In this particular embodiment, the cannula 14 can be formed ofan elastic and/or flexible band 22 that is wound into the shape of ahelix, spring, and/or spiral. Helical coils 23 of the flexible band 22can define a lumen of the cannula 14. The helical coils 23 can each bemated to adjacent coils 23 such that there is no space between the coils23, or alternatively, a sheath or other connecting element can bedisposed within and/or around the coils 23 to mate the coils 23 andprevent fluid flow therebetween. While any mating mechanism known in theart can be used to mate adjacent coils 23, in the illustratedembodiment, each coil 23 can have one of a male and female rail and/ortrack formed on each proximal and distal end that is configured to matewith a corresponding male or female track on an adjacent coil 23. Inthis way, the coils 23 can interlock together. For example, asillustrated in FIG. 1C, each coil can have interlocking end portions 27similar to a zip lock connection that secures the coils together.

A proximal-most end of the flexible band 22 of the cannula 14 can becoupled to an actuator 26 positioned within the housing 12. The actuator26 can take any form known in the art, but in one exemplary embodiment,the actuator 26 can have an external portion 28 that can be gripped by auser to facilitate rotation. The actuator 26 can further include aninternal circular wheel 29 that is coupled to the external portion 28and that can be rotated in either direction relative to the housing 12and relative to the cannula 14 via the external portion 28. Theproximal-most end of the flexible band 22 can be attached to and/orwound around the circular wheel such that rotation of the actuator 26 ina first direction is effective to wind the flexible band 22 around thecircular wheel. In addition, rotation of the actuator 26 in a secondopposite direction is effective to unwind the flexible band 22 fromaround the circular wheel. The first and second directions are generallyopposite directions and can be either clockwise or counter-clockwise asneeded. In the illustrated embodiment, the first direction is clockwiseand the second direction is counter-clockwise.

Rotation of the actuator 26 in the first direction can wind the flexibleband 22 around the circular wheel, thereby tightening the helicalcannula 14 into an insertion configuration. Because the coils 23 areinterlocked together as described above, tightening of the flexible band22 causes the helical cannula 14 to decrease in diameter and thusincrease in length to facilitate easier insertion of the cannula 14 intoa tissue opening. Rotation of the actuator 26 in the second directioncan unwind the flexible band 22 from around the circular wheel, therebycausing the helical cannula 14 to increase in diameter and decrease inlength into an anchoring and/or deployed configuration. The deployedconfiguration can cause the cannula 14 to press against the tissue andcan allow the cannula 14 to act as an anchor against tissue within theopening to stabilize the access device 10. In some embodiments, thecannula 14 can act as a distal anchor within the tissue and the housing12 can act as a proximal anchor on the surface of the tissue tostabilize the device 10 on both sides of the tissue. Due to the natureof the flexible band 22 having an expanded diameter in the deployedconfiguration, a biasing spring force can be created between the cannula14 and the housing 12, thereby providing stabilization for the device.

In some embodiments, the cannula 14 can be biased to the deployedconfiguration and/or to the insertion configuration. In otherembodiments, the device 10 can include a latch mechanism or otherlocking feature to lock the cannula 14 in either of the deployed andinsertion configurations. The cannula 14 can also be formed of amaterial that can cause the cannula 14 to be biased to one or other ofthe deployed and insertion configurations and/or to return to thedeployed or insertion configuration under specific conditions.

In use, the actuator 26 of the surgical access device 10 can be rotatedin the first direction to move the cannula 14 to the insertionconfiguration in which the cannula 14 increases in length and decreasesin diameter. The cannula 14 can then be inserted into an opening in apatient through which a surgical procedure is to be performed. Onceinserted, the actuator 26 can be rotated in the second direction tocause the cannula 14 to decrease in length and increase in diameter. Thecannula 14 can increase in diameter until it contacts and appliesnominal pressure against sidewalls of the tissue opening. In this way,the cannula 14 can act as both an anchor within the tissue opening and aworking channel through the tissue opening through which a procedure canbe performed. Once the procedure is complete, the actuator 26 can onceagain be rotated in the first direction to wind the flexible band 22around the circular wheel of the actuator 26. The decreasing diameter ofthe cannula 14 causes the cannula 14 to disengage from the tissueopening. The surgical access device 10 can then be removed from thetissue opening.

In another embodiment illustrated in FIGS. 2A and 2B, an adjustablesurgical access device 50 is provided having a housing 52 with a cannula54 extending therefrom. An insertion configuration of the surgicalaccess device 50 is shown in FIG. 2A, and a deployed configuration isshown in FIG. 2B. The housing 52 of the surgical access device 50 caninclude any number of sealing ports as needed, for example, two, three,four, etc., but in the illustrated embodiment, the housing has a singlesealing port 56 extending therethrough with a central longitudinal axisaligned with a central longitudinal axis of the surgical access device50. The cannula 54 can have many configurations, but in the illustratedembodiment, the cannula 54 is formed from a plurality of flexible fibers62 woven into a mesh material. The individual fibers 62 can be formedfrom any material, including, but not limited to polypropylene,polyethylene, nylon and/or liquid crystal polymer. These fibers 62 canbe woven into a mesh material and, in some embodiments, can be disposedwithin and/or around a flexible sheath or other protective covering toprevent instruments from snagging on the mesh when they are insertedthrough the cannula 54.

The cannula 54 can be moved between the insertion configuration and thedeployed configuration. As shown in the insertion configuration in FIG.2A, the cannula 54 can be elongate and can have a distal rim 64 that isinverted radially outward from the cannula 54. In other embodiments, thecannula 54 can be an elongate cylinder without an inverted distal rim 64in the insertion configuration. In some embodiments, the cannula 54 caninitially be telescoped within the housing 52 in the insertionconfiguration. As a tissue puncturing element, for example, anobturator, is inserted through the housing 52 to facilitate insertion ofthe device 50 into tissue, the cannula 54 can be telescoped out of thehousing 52 by the obturator and into its elongate form shown in FIG. 2A.In the deployed configuration, the cannula 54 can be retroflexedradially outward, as shown in FIG. 2B, such that the retroflexed distalportion of the cannula 54 has a diameter D1 substantially greater thanthe a diameter D2 of the proximal portion of the cannula 54, and greaterthan a maximum diameter D3 of the distal rim 64 in the insertionconfiguration.

A proximal end of the cannula 54 can be coupled to an actuator 60disposed on the housing 52. Rotation of the actuator 60 can be effectiveto move the cannula 54 between the insertion and deployedconfigurations. For example, since the distal end 66 of the cannula 54is flipped radially outward, rotation of the actuator 60 in a firstdirection can cause the cannula 54 to continue to retroflex outward andupward as it moves to the deployed configuration. As noted above, thecannula 54 can be formed from a plurality of fibers 62. Shortening somefibers 62 while leaving other fibers 62 loose at their original lengthcan cause the cannula 54 to roll outward at the distal end. Thus, afirst group of fibers 62 can be attached to the actuator 60, while asecond group of fibers 62 are not. For example, every third, fourth,fifth, etc. fiber 62 in the mesh material can be attached to theactuator 60 such that when the actuator 60 is rotated in the firstdirection, only those fibers 62 that are attached to the actuator 60will rotate with the actuator 60 and thereby be tightened and shortened.The shortening of the first group of fibers 62 while the second group offibers 62 remain their original length will cause the cannula 54 toretroflex radially outward and upward (i.e., proximally). Rotation ofthe actuator 60 in a second direction can lengthen the first group offibers 62 coupled to the actuator 60 and thereby cause the cannula 54 torelax back to its elongate shape in the insertion configuration. As willbe appreciated by those skilled in the art, the first and seconddirections can generally be in opposite directions and can each beclockwise or counter-clockwise as needed. In the illustrated embodiment,the first direction is in the counter-clockwise direction as shown inFIG. 2A, and the second direction is in the clockwise direction.

When the actuator 60 is rotated to cause the cannula 54 to retroflexradially outward and upward, the distal rim 64 of the cannula 54 can actas an anchor against an inner surface 68 of tissue 70 to assist instabilizing the access device 50. The actuator 60 can have a tighteningassembly, for example, a ratchet style slip-clutch tightening assembly74, that prevents the cannula 54 from overstressing the inner surface 68of the tissue 70 as the cannula is inverted. The slip clutch assembly 74can have detents that resist inadvertent dilation or uncoiling of themechanism. The detents act as a resting location to hold the housinghead in its desired rotation, and due to a mechanical disadvantage,forces on the cannula cannot reverse the actuator 60. Once the distalrim 64 of the cannula 54 encounters resistance from the tissue 70, theslip-clutch or other protection mechanism prevents further tightening ofthe first group of fibers 62, and thereby prevents the distal rim 64 ofthe cannula 54 from pressing harder against the tissue 70. In this way,the distal end 66 of the cannula 54 can act as an anchor to stabilizethe device. In some embodiments, the housing 52 can act as a proximalanchor while the distal end of the cannula 54 acts a distal anchor tofurther stabilize the device 50.

In use, the surgical access device 50 can be inserted into a tissueopening 72 using, for example, an obturator 76. Once the cannula 54 isin position within the opening 72, the actuator 60 can be rotated in thefirst direction to cause the cannula 54 to retroflex radially outwardand upward into engagement with the inner surface 68 of the tissue 70.In this way, the cannula 54 acts as both an anchor within the tissueopening 72 and a working channel through the tissue opening 72 throughwhich a procedure can be performed. Once the procedure is complete, theactuator 60 can be rotated in the second direction to release the firstgroup of fibers 62 of the cannula 54, allowing the cannula 54 to returnto its elongate configuration. The surgical access device 50 can then beremoved from the tissue opening 72.

In a further embodiment illustrated in FIGS. 3A-3C, a surgical accessdevice 100 is provided having a housing 102 with a cannula 104 extendingtherefrom. The housing 102 can include any number of sealing ports asneeded, for example, two, three, four, etc., but in the illustratedembodiment, the housing 102 can include a single sealing port 106extending therethrough with a central longitudinal axis aligned with acentral longitudinal axis of the surgical access device 100. As shown,the cannula 104 can include retractable bellows 108 that can be expandedand retracted as need for insertion and anchoring. The bellows 108 canhave foldable walls that can fold together in response to retraction.The folds in the bellows 108 can be equally spaced and/or can be spacedfurther apart at a distal end of the bellows 108. A proximal end of thecannula 104 can have a radial lip 110, shown in FIG. 3C, that canslidably mate with a distal end 112 of the housing 102 such that thehousing 102 can be rotated relative to the cannula 104 without causingrotation of the cannula 104. Any mating technique known in the art canbe used, but in one exemplary embodiment, there can be a slidableinterference fit between the radial lip 110 and the distal end 112 ofthe housing 102.

The cannula 104 can also include a set of telescoping inner tubes 114 a,114 b disposed inside the retractable bellows 108. The telescoping innertubes 114 a, 114 b can be arranged vertically inside the retractablebellows 108, one on top of the other, such that a distal tube 114 bmoves inside a proximal tube 114 a when the bellows 108 are retracted ina proximal direction toward the housing. The tubes 114 a, 114 b can bejoined by, for example, a sliding joint or they can be threaded togetherat a distal end of the proximal tube 114 a and a proximal end of thedistal tube 114 b. The set of telescoping tubes 114 a, 114 b can providea smooth cylindrical working channel through the cannula 104 forsurgical instruments even when the bellows 108 are retracted, as shownin FIG. 3C.

One or more tension cables, preferably two tension cables 116, canextend proximally from opposed sides of a distal end ring 118 of thecannula 104 to an actuator 120 disposed within the housing 102. In oneexemplary embodiment, the cables 116 can be positioned between thebellows 108 and the inner telescoping tubes 114 a, 114 b, although theycan also be positioned outside of the bellows 108 or inside of thetelescoping tubes 114 a, 114 b. A proximal end of the cables 116 can becoupled to a circular wheel 122 of the actuator 120 such that rotationof an external portion 123 of the actuator 120 in a first direction canwind the cables 116 around the circular wheel 122. This can cause alength of the cables 116 to shorten, thereby drawing the distal end ring118 proximally. This can force the bellows 108 to collapse and thetelescoping tubes 114 a, 114 b to telescope proximally. A proximalportion of the bellows 108 that is disposed within tissue 126 cancollapse more easily than the bellows portion outside of the tissue andthus can be caused to expand outward into engagement with a tissueopening 128. A distal portion of the bellows 108 not disposed within thetissue 126 can be pulled against an inner surface 124 of the tissue 122and can anchor against the tissue 126 to help stabilize the accessdevice 100. Rotation of the actuator 120 in a second direction canunwind the cables 116 from the circular wheel 122 of the actuator 120,thereby lengthening the cables 116 and causing the bellows 108 to unfoldfrom their collapsed configuration. As will be appreciated by thoseskilled in the art, the first and second directions can generally be inopposite directions and can each be clockwise or counter-clockwise asneeded. In the illustrated embodiment, the first direction is in theclockwise direction as shown in FIG. 3C, and the second direction is inthe counter-clockwise direction.

In use, the surgical access device 100 can be inserted into the opening128 in a patient, e.g., using an obturator 130, as shown in FIGS. 3A and3B. The retractable bellows 108 can be in an extended reduced diameterconfiguration during insertion. After the obturator 130 is withdrawn,the actuator 120 can be rotated in the first direction to wind thetension cables 116 around the circular wheel 122. Rotation of theactuator 120 is effective to pull the distal end ring 118 of the bellows108 proximally, causing the bellows 108 to collapse and retract againstthe tissue surface 124, thereby expanding the size of the openingthrough the tissue. The distal telescoping tube 114 b can retract insidethe proximal telescoping tube 114 a providing a smooth working channelthrough which a surgical procedure can be performed. The retractedbellows 108 can engage an inner surface of the tissue and can act as ananchor against the tissue to stabilize the access device 100. Once thesurgical procedure is complete, the actuator 120 can be rotated in thesecond direction to unwind the tension cables 116. This causes thetension cables 116 to lengthen, thereby releasing the retractablebellows 108 back to an insertion configuration so that the surgicalaccess device 100 can be removed from the tissue opening 128.

Another embodiment of a surgical access device is illustrated in FIGS.4A and 4B. A surgical access device 150 is provided having a housing 152with a deployment shaft 154 extending therefrom. The housing 152 caninclude any number of sealing ports as needed, for example, two, three,four, etc., but in the illustrated embodiment, the housing 152 has asingle sealing port 156 extending therethrough with a centrallongitudinal axis aligned with a central longitudinal axis of thesurgical access device 150. The surgical access device 150 can alsoinclude a housing base 158 having a cannula 160 extending therefrom. Thecannula 160 can include a mesh anchor 162 coupled to a distal end 164thereof for providing stabilization of the surgical access device 150.The mesh anchor 162 can be disposed inside the cannula 160 duringinsertion of the cannula 160 into a tissue opening 166. Once the cannula160 is in position within the tissue opening 166, the deployment shaft154 can be inserted into the cannula 160 to push the mesh anchor 162 outof the cannula 160. Once the mesh anchor 162 is deployed from thecannula 160, it can expand radially outward from the distal end 164 ofthe cannula 160 and retroflex proximally against an inner surface 168 oftissue 170 to provide stabilization for the access device 150. Thehousing 152 can sit flush against the housing base 158, and thedeployment device 154 can be positioned within the cannula 160 toprovide a working channel through the device 150 through whichinstruments can be inserted. The mesh anchor 162 can be formed of anysuitable material known in the art, including, but not limited to, anelastic material or a shape memory material such as nitinol, and/orother materials such as polypropoleye, polyetholene, nylon, sanoprene,isoplast, isoprene, etc.

In a further exemplary embodiment illustrated in FIGS. 5A-5C, a surgicalaccess device 200 is provided having a cannula 204 with a housing base202. As will be appreciate by those skilled in the art, any suitablehousing and seal system can be used with the access device 200. Theaccess device 200 can have one or more deployable anchors that canprovide anchoring for the access device 200. For example, the accessdevice 200 can include one or more flexible wires 206 that can extendthrough eye hooks 208 or other restraining mechanisms along a sidewall210 of the cannula 204. The wire 206 can extend from a proximal end 212of the cannula 204 to a distal end 214 of the cannula in an insertionconfiguration, as shown in FIG. 5A. Once the access device 200 isdisposed within a tissue opening 216, the wire 206 can be pushed throughthe eye hook 208 to cause the wire 206 to extend radially outward fromthe cannula 204 at the distal end 214 of the cannula 204. In someembodiments, two wires 208 can be used to provide two “lobes” extendingradially outward from the distal end of the cannula. The lobes can restagainst an inner surface 218 of tissue 220 and provide stabilization forthe device 200. In other embodiments, three, four, or more wires 208 canbe used to extend radially outward from the cannula 204 as shown in FIG.5C, providing additional stabilization. Once a surgical procedure iscomplete, the wires 208 can be pulled proximally through the eye hook208 so that the device 200 can be removed from the opening 216.

In another exemplary embodiment illustrated in FIGS. 6A-6C, a surgicalaccess device 250 is provided having a housing 252 with a cannula 254extending therefrom. The housing 252 can include any number of sealingports as needed, for example, two, three, four, etc., but in theillustrated embodiment, the housing 252 has a single sealing port 256extending therethrough with a central longitudinal axis aligned with acentral longitudinal axis of the surgical access device. The housing 252can be positioned on a housing base 258 and can include an actuator 260formed therein for controlling movement of the cannula 254, as will bedescribed below. The actuator 260 can rotate relative to the housing252, the housing base 258, and the cannula 254 by means of a ratchetmechanism 262. A bottom portion of the ratchet mechanism 262 can bedisposed on the housing base 258 and a top portion of the ratchetmechanism 262 can be disposed on the rotatable actuator 260.

The cannula 254 can be formed of a flexible material, for example,polypropoleye, polyetholene, nylon, sanoprene, isoplast, isoprene, etc.,and can include a plurality of stability rings 264 positioned inside thecannula 254. The stability rings 264 can be circular, substantiallyrigid structures that are positioned at angles, for example, 45 degreeangles, within the cannula 254 when the cannula 254 is in an insertion(reduced diameter) configuration as shown in FIG. 6A. As willappreciated by those skilled in the art, the stability rings 264 can bepositioned at any angle within the cannula 254 as needed, including fromabout 5 degrees to about 175 degrees. The stability rings 264 can givestructure to the flexible cannula 254, causing it to maintain acylindrical shape. In some embodiments, the stability rings 264 can bedisposed on an inner surface of the cannula 254. In other embodiments,the cannula 254 can include an inner sheath, and the stability rings 264can be disposed between the flexible cannula 254 and the inner sheath.

In some embodiments, the stability rings 264 can be connected by asuture 266 that extends from a distal end 268 of the cannula 254 upthrough the actuator 260. Each stability ring 264 can be connected tothe suture 266 on one side thereof, as shown in FIGS. 6A and 6B, oralternatively can be connected to one or more sutures at variouslocations. As the actuator 260 is rotated, the suture 266 can be wrappedaround the actuator 260 causing the suture 266 in the cannula 254 toshorten and to pull up on the distal end 268 of the cannula 254. As thedistal end 268 of the cannula 254 moves toward the housing 252, thestability rings 264 can collapse together, and the flexible cannula 254can expand outward until tissue 270 is engaged, thereby increasing thesize of the opening through the tissue.

In use, the access device 250 can be inserted into a tissue opening 272in the insertion configuration as shown in FIG. 6A. Once within thetissue 270, the actuator 260 can be rotated in a first direction to windthe suture 266 up around the actuator 260 and shorten its length. Thiscauses the suture 266 to pull up on the distal end 268 of the cannula254, collapsing the flexible cannula 254 and the stability rings 264against an inner surface 274 of the tissue 270. This anchors the cannula254 against the tissue 270, providing stability to the access device250. A slip clutch ratchet mechanism, or other such protectionmechanism, can prevent the actuator 260 from over tightening the cannula254 against the tissue 270. The flexible cannula 254 and the stabilityrings 264 can bulge outward so that a smooth interior surface ismaintained through which an instrument can be inserted during a surgicalprocedure. Once the procedure is complete, the actuator 260 can berotated in a second direction to unwind the suture 266 and to relax theflexible cannula 254. As will be appreciated by those skilled in theart, other release mechanisms can be used such as a button on theactuator 260 that releases the suture 266 or a pull tab on the actuator260 that releases the suture 266. As will be appreciated by thoseskilled in the art, the first and second directions can generally be inopposite directions and can each be clockwise or counter-clockwise asneeded. In the illustrated embodiment, the first direction is in thecounter-clockwise direction as shown in FIG. 6B, and the seconddirection is in the clockwise direction.

In another embodiment illustrated in FIGS. 7A-7D, a surgical accessdevice 300 is provided having a housing base 302, an actuator 304, and acannula 306 extending from the housing base 302. While a housing is notshown, it will be appreciated by those skilled in the art that anyhousing known in the art can be used with the surgical access device300. The cannula 306 can be formed of a flexible material, for example,polypropoleye, polyetholene, nylon, sanoprene, isoplast, isoprene, etc.,and can couple to the housing base 302 by any mating mechanism known inthe art, including, but not limited to, adhesive, interference fit,fasteners, etc. A distal end 310 of the cannula 306 can include aflexible retention ring 308 disposed therein. The retention ring 308 canhave a diameter in the deployed configuration that is greater than adiameter of the flexible cannula 306 such that the distal end 310 of thecannula 306 can flare radially outward toward the retention ring 308.

The access device 300 can include an obturator 322 for inserting theaccess device 300 into a tissue opening 324 and for retaining thecannula 306 in an insertion configuration. As shown, the obturator 322can include an elongate body 332 having a sharp tissue penetratingdistal end 326 and a rotatable head 328 on its proximal end. Since theretention ring 308 has a diameter greater than a diameter of the cannula312, insertion into the tissue opening 324 can be hindered by the largerretention ring 308. Accordingly, the obturator 322 can include one ormore latches 330 disposed near its distal end 326 that extend radiallyoutward from the elongate body 332 for retaining the retention ring 308of the cannula 306. The latches 330 hold the retention ring 308 againstthe body of the obturator 322 such that the radius of the cannula 306remains constant during insertion. A mechanical or electrical couplingmechanism can be disposed within the obturator 322 between the latches330 and the rotatable head 328. In this way, the rotatable head 328 ofthe obturator 322 can be rotated in a first direction to actuate theelectrical or mechanical coupling mechanism to cause the latches 330 toretract inside the elongate body 332 and release the retention ring 308of the cannula 306.

The cannula 306 can also include one or more sutures 312 extending fromthe retention ring 308 to the actuator 304. In one embodiment, thesuture 312 can be embedded in a sidewall of the flexible cannula 306. Asthe actuator 304 is rotated, the suture 312 is wound around a circularwheel 314 in the actuator 304, causing the suture 312 to shorten. Theshortening of the suture 312 pulls up on the retention ring 308 causingthe flexible cannula 306 to collapse and pull the ring 308 up toward thehousing base 302 until it is secure against an inner surface 316 of thetissue 318. Once secure against the surface 316, the collapsed portionof the cannula 306 can act as an anchor for the access device 300,providing stability thereto. A pull tab 320 extending from the housingbase 302 can be connected to the actuator 304 such that pulling on thetab 320 releases the suture 312, thereby relaxing the cannula 306 backto an insertion configuration.

In use, the surgical access device 300 can be inserted into the tissueopening 324 using the obturator 322. The obturator 322 can be disposedinside the cannula 306 and the latches 330 on the obturator 322 canretain the retention ring 308 of the cannula 306, as shown in FIG. 7A.Once inserted inside the tissue 318, the rotatable head 328 of theobturator 322 can be rotated to cause the latches 330 to retract insidethe obturator 322, thereby releasing the retention ring 308, as shown inFIG. 7B. The obturator 322 can then be removed from the flexible cannula306. In order to anchor the cannula 306 against the tissue 318 forstability, the actuator 304 can be rotated in a first direction totighten the suture 312 and pull up on the retention ring 308 of thecannula 306. This can cause the cannula 306 to collapse and pull thering 308 against the inner surface 316 of the tissue 318. Once asurgical procedure is completed, the tab 320 can be pulled to releasethe suture 312, thereby relaxing the cannula 306 and allowing it toreturn to its insertion configuration for removal from the tissueopening 324.

As will be appreciated by those skilled in the art, any and all of theembodiments disclosed herein can be interchangeable with one another asneeded. For example, an exemplary surgical access device kit couldinclude multiple housings and seal bases with one or more cannulas.Various release mechanisms known in the art can be used to releasablyattach the various cannulas to a housing.

There are various features that can optionally be included with any andall of the surgical access device embodiments disclosed herein. Forexample, a component of the device, such as a seal, housing, cannula,etc., can have one or more lights formed thereon or around acircumference thereof to enable better visualization when insertedwithin a patient. As will be appreciated, any wavelength of light can beused for various applications, whether visible or invisible. Any numberof ports can also be included on and/or through the surgical accessdevices to enable the use of various surgical techniques and devices asneeded in a particular procedure. For example, openings and ports canallow for the introduction of pressurized gases, vacuum systems, energysources such as radiofrequency and ultrasound, irrigation, imaging, etc.As will be appreciated by those skilled in the art, any of thesetechniques and devices can be removably attachable to the surgicalaccess device and can be exchanged and manipulated as needed.

The embodiments described herein can be used in any known and futuresurgical procedures and methods, as will be appreciated by those skilledin the art. For example, any of the embodiments described herein can beused in performing a sleeve gastrectomy and/or a gastroplasty, asdescribed in U.S. application Ser. No. 12/242,765 entitled “SurgicalAccess Device” filed on Sep. 30, 2008; U.S. application Ser. No.12/242,711 entitled “Surgical Access Device with Protective Element”filed on Sep. 30, 2008; U.S. application Ser. No. 12/242,721 entitled“Multiple Port Surgical Access Device” filed on Sep. 30, 2008; U.S.application Ser. No. 12/242,726 entitled “Variable Surgical AccessDevice” filed on Sep. 30, 2008; U.S. application Ser. No. 12/242,333entitled “Methods and Devices for Performing Gastrectomies andGastroplasties” filed on Sep. 30, 2008; U.S. application Ser. No.12/242,353 entitled “Methods and Devices for Performing Gastrectomiesand Gastroplasties” filed on Sep. 30, 2008; and U.S. application Ser.No. 12/242,381 entitled “Methods and Devices for PerformingGastroplasties Using a Multiple Port Access Device” filed on Sep. 30,2008, all of which are hereby incorporated by reference in theirentireties.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination,e.g., a seal, a housing, a cannula, etc. Upon cleaning and/orreplacement of particular parts, the device can be reassembled forsubsequent use either at a reconditioning facility, or by a surgicalteam immediately prior to a surgical procedure. Those skilled in the artwill appreciate that reconditioning of a device can utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

Preferably, the invention described herein will be processed beforesurgery. First, a new or used instrument is obtained and if necessarycleaned. The instrument can then be sterilized. In one sterilizationtechnique, the instrument is placed in a closed and sealed container,such as a plastic or TYVEK bag. The container and instrument are thenplaced in a field of radiation that can penetrate the container, such asgamma radiation, x-rays, or high-energy electrons. The radiation killsbacteria on the instrument and in the container. The sterilizedinstrument can then be stored in the sterile container. The sealedcontainer keeps the instrument sterile until it is opened in the medicalfacility.

It is preferred that device is sterilized. This can be done by anynumber of ways known to those skilled in the art including beta or gammaradiation, ethylene oxide, steam, and a liquid bath (e.g., cold soak).

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

1. An adjustable access device, comprising: a housing having anadjustable cannula extending distally therefrom, the adjustable cannulabeing formed of a plurality of fibers woven into a mesh material andbeing movable between an insertion configuration and a deployedconfiguration in which a distal portion of the cannula retroflexesupward and radially outward toward a proximal portion of the cannula toform an anchor configured for stabilizing the access device; and arotatable actuator disposed on the housing and configured to move thecannula between the insertion configuration and the deployedconfiguration, wherein the rotatable actuator is, configured to decreasea length of at least some of the plurality of fibers extending from thehousing to move the cannula to the deployed configuration.
 2. Theadjustable access device of claim 1, wherein the cannula is configuredto telescope within the housing in the insertion configuration.
 3. Theadjustable access device of claim 1, wherein the anchor has a diametergreater than a diameter of the proximal portion of the cannula.
 4. Anadjustable access device, comprising: a housing; a cannula formed of aweave of fibers extending distally from the housing, the housing and thecannula defining a working channel extending therethrough for receivinginstruments; and an actuator rotatably disposed on the housing such thatrotation of the actuator in a first direction relative to the housing iseffective to cause a distal portion of the cannula to retroflex upwardand radially outward into a deployed configuration to form a distalanchor to engage tissue, wherein a first group of fibers from the weaveof fibers is coupled to the actuator, and a second group of fibers fromthe weave of fibers is not coupled to the actuator.
 5. The adjustableaccess device of claim 4, wherein the distal anchor includes a distalrim configured to engage tissue when the distal anchor is in thedeployed configuration.
 6. The access device of claim 4, whereinrotation of the actuator in the first direction is effective to shortena length of the first group of fibers.
 7. The adjustable access deviceof claim 6, wherein the second group of fibers is configured to maintainan original length when the actuator is rotated in the first direction.8. The adjustable access device of claim 4, wherein the housing includesmultiple sealing ports formed therein.
 9. The adjustable access deviceof claim 4, wherein the actuator is rotatable in a second oppositedirection to move the anchor portion of the cannula from the deployedconfiguration to an insertion configuration in which the cannula has asubstantially constant outer diameter.
 10. The adjustable access deviceof claim 4, wherein the cannula is configured to telescopelongitudinally through the housing when the actuator is rotated in thefirst direction.
 11. The adjustable access device of claim 4, whereinthe anchor portion has a diameter substantially greater than a diameterof the cannula when in the deployed configuration.
 12. The adjustableaccess device of claim 4, further comprising at least one sealingelement disposed within the working channel, the at least one sealingelement being effective to form at least one of a seal around aninstrument inserted through the working channel and a seal across theworking channel when no instrument is inserted through the workingchannel.